Infants who have non-fused suture lines with open fontanel’s have a degree of compensation before signs of increased ICP are evident, such as macrocephaly. Signs may be unilateral or bilateral depending on the cause of the intracranial hypertension.Īt a critically high level of ICP, spontaneous respiration is depressed, hypertension occurs, and heart rate is slowed, this is known as Cushing’s triad. With severe intracranial hypertension, consciousness becomes depressed, tone and reflexes of the limbs are altered, pupils enlarge, papillary reaction to light is sluggish and spontaneous movement of the limbs is decreased. Common clinical signs of early intracranial hypertension include headache, vomiting, irritability, seizures, photophobia, lethargy, nystagmus, and diplopia. Increased ICP is usually defined as sustained rises above 15mmHg. Nursing Assessment guideline for more information. Physical assessment including completing ABCD and neurological assessment on the paediatric patient with an EVD/ICP monitor and documenting is required at the beginning of each shift and PRN in relation to the patient’s condition. In the presence of infection in the surrounding area which includes the skin, subcutaneous tissue, bone and the epidural space.Patients with Chiari Malformation or tonsillar ectopia.In the presence of a mass lesion such as a brain tumour.The patient with non-communicative hydrocephalus.The patient is receiving anticoagulation therapy or who are known to have coagulation problems.Ī lumbar catheter for drainage and monitoring of CSF is contraindicated in the following patients:.Patients who may need an objective 48hours of monitoring of their ICP to help clarify symptoms or the significance of scan findingsĪ lumbar CSF drain may be used for treatment of CSF leak as part of post-operative care, or in some circumstances, if a ventricular drain is contraindicated.Īn EVD/ICP monitor is contraindicated in the following patients:.ICP monitoring may be used in patients with: In patients with a severe head injury to provide both a means of measuring ICP and allowing CSF drainage to treat raised ICPĪn ICP monitoring probe may be placed either at the same time as an EVD or separately, in patients where monitoring ICP is vital.To enable drainage of infected CSF (e.g.Following surgery, particularly tumour surgery, until the CSF circulation is re-established.Standard Aseptic Technique: Aims to prevent pathogenic microorganisms in sufficient quantity to cause infection, from being introduced to susceptible sites by hands, surfaces and equipment.Meningitis: An inflammation or infection of the protective membranes and fluid that surround the brain.Whilst this is commonly associated with enlargement of the ventricle, in some circumstances the ventricles do not increase in size. Hydrocephalus: A disorder of the CSF circulation leading to raised pressure in the CSF.Lumbar drainage devices: A temporary device allowing drainage of cerebral spinal fluid (CSF) from the subarachnoid space to an external closed system.Intracranial pressure (ICP) monitoring: A temporary device allowing measurement and recording of intracranial pressure.External ventricular drain (EVD): A temporary system that allows drainage of cerebral spinal fluid (CSF) from the ventricles to an external closed system.This guideline is aimed at RCH staff involved in the use and management of EVD and ICP monitoring. The CSF circulates around the brain and spinal cord and is then reabsorbed via the arachnoid villi. The ventricular system produces CSF at approximately 20mL/hr (estimated at 0.35mL/min in children) by the choroid plexus in the lateral ventricles. ICP can be monitored via a fibre optic monitor (Codman™ microsensor) which is placed on the surface of the brain or in the brain or an external ventricular drain (EVD) system which is a closed sterile system allowing drainage of CSF via a silastic catheter tip which rests in the ventricle. If there is not, an increase in intracranial pressure (ICP) will occur. As the volume of the three components within the skull (brain matter, blood and CSF) must remain equal, an increase in one component must be accompanied by a decrease in another component. After closure of a child’s sutures, the cranial vault is similar to a rigid box. The cranial vault contains brain tissue, blood and cerebrospinal fluid (CSF).
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